Ebola Outbreak Prompts Concern for Impact of Other Infectious Diseases

Sep 29, 2014, 2:23 PM

As the number of cases and deaths soar, the Ebola outbreak in West Africa is rightfully front and center in the news, both in terms of the disease’s progress and of the need for funds and manpower. However, infectious disease specialists are urging public health leaders to also stay vigilant in preventing and handling outbreaks of many other infectious diseases. Earlier this month, the White House issued the first ever executive order on antibiotic resistance to help prevent the 20,000 U.S. deaths that occur each year because of infections are resistant to available antibiotics.

Writer David Olsen reported last week in GlobalHealthHub that, based on figures from the World Health Organization (WHO) and UNAIDS, at least three disease in West Africa are currently claiming more lives than Ebola: Malaria, tuberculosis and AIDS. No one is suggesting a slow down in the Ebola efforts—in fact public health experts are urging ever greater ramping up—but as Olsen points out, “another of [Ebola’s] terrible legacies may be that it will distract attention and resources from other diseases that are killing far more people worldwide.”

Over the next few weeks NewPublicHealth will be doing a series of research and outbreak updates on several infectious diseases and their impact in both the United States and globally, starting today with HIV/AIDS.

This Saturday was HIV/AIDS awareness day for U.S. gay and bisexual men. According to the U.S. Centers for Disease Control and Prevention (CDC), one in five gay men in 20 major cities is estimated to be HIV positive, with about one third not knowing they are positive. The Kaiser Family Foundation (KFF) estimates that, based on CDC data, 12-13 percent of gay men are HIV positive and that there is evidence that the situation is worsening. Between 2008 and 2010, the CDC reported new infections rose 12 percent overall among gay men, and 22 percent among younger gay men, with the highest increases among men of color.

A new survey released late last week by KFF found that at a time when infections among gay and bisexual men are on the rise, more than half of gay and bisexual men say they are not personally concerned about becoming infected; only three in ten say they were tested for HIV within the last year, despite CDC recommendations for at least annual testing, with even more frequent testing recommended by many health departments.

The survey also found that gay and bisexual men ages 18 to 35 are twice as likely as those who are older to report never having been tested for HIV.

Other findings of the survey:

Only about a quarter of gay and bisexual men know about PrEP (pre-exposure prophylaxis), a daily medication that people who are HIV-negative can take to lower their risk of becoming infected.

Fewer than half of gay and bisexual men are aware that the current guidelines for people with HIV are to start antiretroviral (ARV) treatment as soon as they are diagnosed, and only 25 percent know about treatment as prevention. Research shows that taking consistent ARV treatment can reduce the risk of passing HIV on to others by as much as 96 percent.

More than half say that a doctor has never recommended they get tested for HIV, and six in 10 say they rarely or never discuss HIV when they visit their doctor.

Just a third know that new infections are on the rise among gay and bisexual men. One in four think the number is decreasing, and the rest either think the situation is staying the same or say they don’t know.

Many gay and bisexual men say HIV is not a topic that comes up often, and just a third (32 percent) realize that new infections are on the rise among gay and bisexual men. Approximately one in four (22 percent) think the number is decreasing and the rest either think the situation is staying the same or acknowledge that they don’t know.

Reflecting the disproportionate impact of HIV in communities of color, gay and bisexual men who are members of racial and ethnic minority groups are more likely to say that HIV/AIDS is a significant issue for them personally than are white gay men (64 percent versus 42 percent) and to say that they are personally concerned about becoming infected (53 percent versus 28 percent.

Many say HIV is not a topic that comes up often, if at all, even with those closest to them.

Many gay and bisexual men report not talking much about the disease with casual sexual partners (50 percent) or with long-term partners (60 percent).

“These survey results underscore the importance of getting the word out among gay and bisexual men about risk and new treatment and prevention options,” said Kaiser Family Foundation President and CEO Drew Altman, PhD.

Recent study findings have found both promising and some disappointing news with respect to preventing and treating HIV/AIDs. Recently, NewPublicHealth spoke with Jen Kates, PhD, Vice President and Director of the Global Health and HIV Policy Program at the Kaiser Family Foundation about key research findings presented at the International AIDS Conference this summer.

NewPublicHealth: What were the most striking research results?

Jen Kates: There was disappointing news about the baby from Mississippi who was thought to be cured of HIV. He had a prolonged remission of more than two years, but was then found to have detectable levels of the virus, which underscores the difficulty of finding a cure.

But there were also some exciting findings reported, including a strategy called “kick and kill,” which tries to flush out hidden viruses so that it can be targeted by drugs. We also heard reports on the benefits of early antiretroviral treatment both for patients and in order to reduce the chance of HIV transmission to partners who are uninfected.

More research was also shared on the benefits of preexpousre prophylaxis with antiretroviral drugs. Studies presented found that the treatment is highly effective, but also there was no evidence of people increasing their risk behavior because they were on the drugs.

And, just before the conference, the World Health Organization released guidelines on HIV prevention, diagnosis, treatment and care.

But it’s also very important to note a big focus of the conference, and one on which there was broad consensus: That we cannot end AIDS without ending the stigma so many people face, particularly people in key populations such as those who are transgender, sex workers and injectable drug users. This was the subject to the Melbourne Declaration, the official conference declaration, called Nobody Left Behind. There was also a consensus to focus resources on where the epidemic is—geographically as well as by population—to be strategic.

This commentary originally appeared on the RWJF New Public Health blog.

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